<!DOCTYPE html>
<html lang="zh-cn">
    <head>
        <meta charset="utf-8">
        <title>录入</title>
        <meta name="viewport" content="width=device-width, initial-scale=1.0">
        <meta name="renderer" content="webkit">

        <link rel="shortcut icon" href="../../../extends/img/favicon.ico" />
        <!-- Loading Bootstrap -->
        <link href="../../../extends/css/main.css" rel="stylesheet">

        <!-- HTML5 shim, for IE6-8 support of HTML5 elements. All other JS at the end of file. -->
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        <script src="../../../assets/html5shiv.min.js"></script>
        <script src="../../../assets/respond.min.js"></script>
        <![endif]-->
        <script type="text/javascript">
            var require = {
                "config": {
                    "site": {
                        "name": "mse",
                        "cdnurl": "../../../",
                        "version": "1.0.0",
                        "timezone": "Asia/Shanghai",
                        "languages": {
                            "backend": "zh-cn",
                            "frontend": "zh-cn"
                        }
                    },
                    "upload": {
                        "cdnurl": "./",
                        "uploadurl": "/upload/image",
                        "maxsize": "10mb",
                        "mimetype": "*",
                        "multiple": false
                    },
                    "modulename": "biz",
                    "controllername": "add",
                    "actionname": "init",
                    "jsname": "main/js/biz/add",
                    "moduleurl": "./",
                    "language": "zh-cn",
                    "referer": null
                }
            };
        </script>
    </head>

    <body class="inside-header inside-aside is-dialog">
        <div id="main" role="main">
            <div class="tab-content tab-addtabs">
                <div id="content">
                    <div class="row text-center">
                        <div class="col-xs-12 col-sm-12 col-md-12 col-lg-12">
                            <div class="content" style="width:1100px;">
                                <form id="edit-form" class="form-horizontal form-ajax" role="form" data-toggle="validator" method="POST" action="/member">
                        			<div id="errtips" class="hide"></div>
	                                <div class="row">
                                        <div class="form-group col-sm-3">
                                            <label class="control-label col-xs-12 col-sm-3" style="max-width: 66px;">
                                                姓名
                                            </label>
                                            <div class="col-xs-12 col-sm-8">
                                                <input type="text" name="userName" class="form-control" placeholder="请输入姓名" data-rule="required">
                                            </div>
                                        </div>
                                        
                                        <div class="form-group col-sm-2">
                                            <label class="control-label col-xs-12 col-sm-4">
                                            性别
                                            </label>
                                            <div class="col-xs-12 col-sm-7">
                                                <select name="sex" class="form-control selectbox">
                                                    <option value="男">男</option>
                                                    <option value="女">女</option>
                                                </select>
                                            </div>
                                        </div>
                                        
                                        <div class="form-group col-sm-3">
                                            <label class="control-label col-xs-12 col-sm-4">
                                            证件类型
                                            </label>
                                            <div class="col-xs-12 col-sm-7">
                                                <select name="cardType" class="form-control selectbox" data-rule="required">
                                                    <option value="身份证">身份证</option>
                                                </select>
                                            </div>
                                        </div>
                                        
                                        <div class="form-group col-sm-4">
                                            <label class="control-label col-xs-12 col-sm-3">
                                            证件号码
                                            </label>
                                            <div class="col-xs-12 col-sm-8">
                                                <input type="text" name="cardNo" class="form-control" placeholder="请输入证件号码" data-rule="required">
                                            </div>
                                        </div>
                                    </div>
                                    
	                                <div class="row">
				                        <div class="form-group col-sm-6">
		                                	<label class="control-label col-xs-12 col-sm-1" style="min-width: 112px;">
				                               身份证地址
				                            </label>
				                            <div class="col-xs-12 col-sm-3">
		                                		<select name="locationProvince" class="form-control selectbox">
	                                       			<option value="">请选择省份</option>
	                                        	</select>
	                                        </div>
				                            <div class="col-xs-12 col-sm-3">
	                                        	<select name="locationCity" class="form-control selectbox">
	                                       			<option value="">请选择县市</option>
	                                        	</select>
	                                        </div>
				                            <div class="col-xs-12 col-sm-3">
	                                        	<select name="locationArea" class="form-control selectbox">
	                                       			<option value="">请选择乡镇</option>
	                                        	</select>
	                                        </div>
	                                     </div>
			                            <div class="col-xs-12 col-sm-5 btns text-right">
			                            	<button type="button" class="btn ">扫描身份证</button>
			                            	<button type="button" class="btn ">扫描社保卡</button>
                                        </div>
	                                </div>
                                    
                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:230px;">
                                            <label class="control-label col-sm-1"  style="min-width:97px;">失能情况</label>
                                            <div class="col-sm-5">
	                                        	<select name="ness.disability" class="form-control selectbox">
	                                        		<option value="">-请选择-</option>
	                                       			<option value="失能">失能</option>
	                                       			<option value="半失能">半失能</option>
	                                        	</select>
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label">
                                                <input type="checkbox" name="ness.invalidism" value="1"> <span>是否残疾</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:70px;">伤残等级</label>
                                            <div class="col-sm-6">
                                                <input type="text" name="ness.invalidismGrade" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:70px;">伤残部位</label>
                                            <div class="col-sm-6">
                                                <input type="text" name="ness.invalidismPosition" class="form-control">
                                            </div>
                                        </div>
                                    </div>
                                    
                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:150px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hasTumour" value="1"> <span>是否患有肿瘤</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.leucemiz" value="1"> <span>白血病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.lymphCancer" value="1"> <span>淋巴癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.mammaryCancer" value="1"> <span>乳腺癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.lungCancer" value="1"> <span>肺癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.liverCancer" value="1"> <span>肝癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.gastricCancer" value="1"> <span>胃癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.pancreaticCancer" value="1"> <span>胰腺癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.gallbladderCancer" value="1"> <span>胆囊癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.colonCancer" value="1"> <span>结肠癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.cervicalCancer" value="1"> <span>宫颈癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.boneCancer" value="1"> <span>骨癌</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:110px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.otherCancer" value="1"> <span>其他癌症</span>
                                            </label>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:165px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.senileDisease" value="1"> <span>是否患有老年病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.pearlEye" value="1"> <span>白内障</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:80px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.foolish" value="1"> <span>痴呆</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:140px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.senilePsychosis" value="1"> <span>老年性精神病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:130px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.prostatauxe" value="1"> <span>前列腺肥大</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hearingLoss" value="1"> <span>耳聋</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.arteriosclerosis" value="1"> <span>动脉硬化</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.varix" value="1"> <span>静脉曲张</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.boneLoss" value="1"> <span>骨质疏松</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:70px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.anemia" value="1"> <span>贫血</span>
                                            </label>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:165px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.chronicDisease" value="1"> <span>是有患有慢性病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.sugarDiabetes" value="1"> <span>糖尿病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hypertension" value="1"> <span>高血压</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hyperlipemia" value="1"> <span>高脂血症</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.cerebralApoplexy" value="1"> <span>脑卒中</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:90px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.coronaryDisease" value="1"> <span>冠心病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:140px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.chronicBronchitis" value="1"> <span>慢性支气管炎</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:120px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.bronchialAsthma" value="1"> <span>支气管哮喘</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:150px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.arthritisPauperum" value="1"> <span>类风湿性关节炎</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:170px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.cerebrovascularSequelae" value="1"> <span>脑血管意外后遗症</span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:155px;">
                                            <label class="control-label col-sm-12">
                                                &nbsp;
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.pulmonaryHeartDisease" value="1"> <span>肺心病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:140px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.rheumaticHeartDisease" value="1"> <span>风湿性心脏病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:155px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.chronicViralHepatitis" value="1"> <span>慢性病毒性肝炎</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:155px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.erythematosus" value="1"> <span>系统性红斑狼疮</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:148px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.coronaryStenting" value="1"> <span>冠脉支架术后</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:140px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hyperthyroidHeartDisease" value="1"> <span>甲亢性心脏病</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:170px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="ness.hypothyroidism" value="1"> <span>甲状腺功能减退症</span>
                                            </label>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:117px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="isAlone" value="1"> <span>是否独居</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:240px;">
                                            <label class="control-label col-sm-1"  style="min-width:110px;">同居人姓名</label>
                                            <div class="col-sm-5">
                                                <input type="text" name="partnerName" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:240px;">
                                            <label class="control-label col-sm-1"  style="min-width:120px;">同居人证件类型</label>
                                            <div class="col-sm-5">
                                                <input type="text" name="partnerCartType" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:80px;">证件号码</label>
                                            <div class="col-sm-7">
                                                <input type="text" name="partnerCartNo" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:150px;">
                                            <label class="control-label col-sm-1"  style="min-width:70px;">子女人数</label>
                                            <div class="col-sm-5">
                                                <input type="text" name="childrenNum" class="form-control">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:175px;">现居住条件（平米）</label>
                                            <div class="col-sm-4">
                                                <input type="text" name="liveArea" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:117px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="liveHasToilet" value="1"> <span>是否有独立卫生间</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:117px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="liveHasCookroom" value="1"> <span>是否有独立厨房</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-3" style="min-width:300px;">
                                            <label class="control-label col-sm-6">
                                                现居住房屋类型
                                            </label>
                                            <div class="col-sm-6">
                                                <select id="liveHouseType" class="form-control">
                                                  <option value="">请选择类型</option>
                                                  <option value="房屋所有权证">房屋所有权证</option>
                                                  <option value="房屋共有权证">房屋共有权证</option>
                                                  <option value="房屋他项权证">房屋他项权证</option>
                                                  <option value="土地使用权证">土地使用权证</option>
                                                  <option value="房地产权证">房地产权证</option>
                                                  <option value="房地产共有权证">房地产共有权证</option>
                                                  <option value="房地产他项权证">房地产他项权证</option>
                                                </select>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:167px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="hasHouse" value="1"> <span>名下是否有房产</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:310px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">房产地址</label>
                                            <div class="col-sm-8">
                                                <input type="text" name="houseAddress" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">房本编号</label>
                                            <div class="col-sm-7">
                                                <input type="text" name="houseNo" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:175px;">现居住房屋产权归属</label>
                                            <div class="col-sm-4">
                                                <input type="text" name="liveHouseOwner" class="form-control">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:250px;">
                                            <label class="control-label col-sm-1"  style="min-width:160px;">
                                                现收入水平（月）
                                            </label>
                                            <div class="col-sm-4">
                                                <input type="text" name="incomeMonth" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:190px;">
                                            <label class="control-label col-sm-1"  style="min-width:90px;">
                                                自身收入
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="incomeSelf" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:110px;">
                                                子女供养收入
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="incomeChild" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:190px;">
                                            <label class="control-label col-sm-1"  style="min-width:90px;">
                                                其他收入
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="incomeOther" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:250px;">
                                            <label class="control-label col-sm-6">
                                                原工作单位性质
                                            </label>
                                            <div class="col-sm-6">
                                                <select id="companyType" class="form-control">
                                                  <option value="">请选择</option>
                                                  <option value="国有企业">国有企业</option>
                                                  <option value="私有企业">私有企业</option>
                                                  <option value="集体企业">集体企业</option>
                                                  <option value="个体经营">个体经营</option>
                                                  <option value="其他">其他</option>
                                                </select>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:112px;">
                                                月生活开支
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="costLiving" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">
                                                吃饭开支
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="costFood" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:100px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="hasLoan" value="1"> <span>有无贷款</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">
                                                还款金额
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="costRepay" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-2" style="min-width:200px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">
                                                其他开支
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="costOther" class="form-control">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:160px;">
                                                教育程度（学历）
                                            </label>
                                            <div class="col-sm-5">
                                                <input type="text" name="education" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:220px;">
                                            <label class="control-label col-sm-1"  style="min-width:90px;">
                                                整治面貌
                                            </label>
                                            <div class="col-sm-6">
                                                <input type="text" name="politicalStatus" class="form-control">
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:200px;">
                                            <label class="control-label col-sm-1" style="min-width:90px;">
                                                宗教信仰
                                            </label>
                                            <div class="col-sm-6">
                                                <select id="religion" class="form-control">
                                                  <option value="">请选择</option>
                                                  <option value="佛教">佛教</option>
                                                  <option value="道教">道教</option>
                                                  <option value="伊斯兰教">伊斯兰教</option>
                                                  <option value="天主教">天主教</option>
                                                  <option value="基督教">基督教</option>
                                                  <option value="犹太教">犹太教</option>
                                                  <option value="其他">其他</option>
                                                </select>
                                            </div>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:300px;">
                                            <label class="control-label col-sm-1"  style="min-width:100px;">
                                                兴趣爱好
                                            </label>
                                            <div class="col-sm-7">
                                                <input type="text" name="hobbies" class="form-control">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:215px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="usePhonePay" value="1"> <span>是否收看收听电视节目</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:700px;">
                                            <label class="control-label col-sm-1" style="min-width:110px;">
                                                常看的频道
                                            </label>
                                            <div class="col-sm-9">
                                                <input type="text" name="tvChannel" class="form-control" placeholder="可填写多个，以逗号分隔。">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:700px;">
                                            <label class="control-label col-sm-1" style="min-width:97px;">
                                                访问网站
                                            </label>
                                            <div class="col-sm-8">
                                                <input type="text" name="website" class="form-control" placeholder="可填写多个，以逗号分隔。">
                                            </div>
                                        </div>
                                    </div>

                                    <div class="row">
                                        <div class="form-group col-sm-1" style="min-width:152px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="usePhone" value="1"> <span>是否使用手机</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:185px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="mentalPhone" value="1"> <span>是否使用智能手机</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:155px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="useWx" value="1"> <span>是否使用微信</span>
                                            </label>
                                        </div>
                                        <div class="form-group col-sm-1" style="min-width:185px;">
                                            <label class="control-label col-sm-12">
                                                <input type="checkbox" name="usePhonePay" value="1"> <span>是否使用移动支付</span>
                                            </label>
                                        </div>
                                    </div>

                                    <div class="form-group">
                                        <div class="col-xs-12 text-center btns">
                                            <button type="submit" class="btn btn-big btn-save">保存</button>
                                        </div>
                                    </div>
                                </form>
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